Treatment of deep-vein thrombosis with streptokinase

Kakkar, Vijay V.; Flanc, C; O’Shea, Margaret; Flute, P.T.; Howe, C. T.; Clarke, Maxine

doi:10.1002/bjs.1800560307

Cited by 53 publications

(13 citation statements)

References 9 publications

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“…25 I-labelled human fibrinogen when injected intravenously is incorporated into a forming thrombus. Repeated counts of radioactivity over the site of thrombus and over areas where there were no thrombi allowed a quantitative assessment of the fate of the thrombus (Kakkar et al, , 1969a. The decrease in the percentage difference of radioactivity over these two sites indicated the rate of thrombus dissolution; this was confirmed by repeated phlebography.…”

Section: Assessment Of Progressmentioning

confidence: 94%

“…The methods used were those described by Alkjaersig et al (1959) for plasminogen, by Ingram (1961) for fibrinogen, by Merskey et al (1966) for fibrin degradation products, and by Kakkar et al (1969a). The dose of heparin was increased within the agreed limits to prolong the thrombin clotting-time beyond the normal of 10 to 15 seconds, but reduced if the time exceeded 120 seconds.…”

Section: Design Of the Trialmentioning

confidence: 99%

“…One group was given the anticoagulant heparin. Another received the plasminogen activator streptokinase (Kabikinase), which is known to have a thrombolytic effect (Browse et al, 1968 ;Kakkar et al, , 1969a. The third group was treated with Arvin, a purified fraction of the Deep Vein Thrombosis- Kakkar et al venom of the Malayan pit viper, which has a specific coagulant action on fibrinogen.…”

Section: Introductionmentioning

confidence: 99%

“…The 52'I-labelled fibrinogen test, known to be effective in the diagnosis of thrombosis (Atkins and Hawkins, 1965 ;Flanc et al, 1968 ;Negus et al, 1968), was extended by repeated observation to follow the decline in radioactivity concentrated over the thrombus. Repeated phlebograms have shown that the decline corresponds for the most part to dissolution of thrombi (Kakkar et al, , 1969a.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Vv¹,

Flanc²,

Howe³

et al. 1969

BMJ

250

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Symptomatic infection developed in 16 of the 45 untreated bacteriuric women (36%). Loin pain and fever developed in onlv two of these subjects, whereas in the remainder the symptoms were frequency and dysuria. Comparison of these findings with the natural history of asymptomatic significant bacteriuria in pregnancy shows that the total incidence of symptomatic infection is similar. The distinguishing feature between the natural history of asymptomatic significant bacteriuria in pregnant and non-pregnant women is the severity of symptoms. Asscher et a!. (1966) showed that in pregnancy the urine is continuously maintained at optimal pH for the growth of urinary pathogens. It may be that the greater severity of symptomatic infections arising in pregnant bacteriuric women is related to this.A single course of treatment initially cured bacteriuria in 80 U, of cases, but was soon followed by relapses and reinfections, particularly in women who had been shown to have radiological abnormalities. One year after treatment, therefore, the cure rates among treated and untreated bacteriuric subjects no longer showed a significant difference. Not surprisingly, therefore, treatment failed to prevent the development of symptoms of overt infection. Moreover, it has been shown that the reinfections which followed treatment were more commonly associated with the development of symptoms than the persistent or relapsing infections in the untreated or unsuccessfully treated subjects. This would suggest that bacteriuric women may have developed tolerance to the particular organism harboured in their urinary tract and that treatment can temporarily upset this equilibrium. The occurrence of tolerance to the pyrogenic substances of Gram-negative bacteria in animals and humans with urinary tract infections has been demonstrated by McCabe (1963) and may explain the more frequent development of symptoms in subjects who are reinfected after treatment.Our observations suggest that a search for significant bacteriuria in non-pregnant female populations does not satisfy either of the principal requirements of a good screening procedure. In many instances it fails to detect urinary tract infection at an early and reversible stage of its natural history (Sussman et al., 1969), and treatment suitable for use on a large scale fails to alter its natural history. The present study still leaves an important gap in our understanding of the clinical significance of bacteriuria-namely, its relationship to the ultimate development of scarring and contraction of the kidneys and of renal failure. It is hoped that long-term follow-up of the bacteriuric and control subjects of this study will help us to provide an answer. At present it seems likely that even if persistent bacteriuria did lead to progressive renal damage its eradication would be difficult, costly, time-consuming, and probably hazardous.

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Section: Assessment Of Progressmentioning

confidence: 94%

Section: Design Of the Trialmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Deep Vein Thrombosis. A Trial of Heparin, Streptokinase, and Arvin

Vv¹,

Flanc²,

Howe³

et al. 1969

BMJ

250

View full text Add to dashboard Cite

show abstract

“…As the majority of pulmonary emboli which occur after surgical operations are red clots which have been displaced from a thrombosed vein in one of the patient's lower limbs (Aschoff, 1924;Homans, 1934;Frykholm, 1940;Hunter, Sneeden, Robertson, and Snyder, 1941;Hunter, Krygier, Kennedy, and Sneeden, 1945;Gibbs, 1957;Sevitt and Gallagher, 1961)~ presumably the incidence of thrombosis in the deep veins of the lower limbs must have also increased during the past 20 years. This possibility cannot be established as there are no facts with which to do it, but the recent introduction of sophisticated methods of diagnosis using phlebography (Bauer, 1946;Kakkar and Flanc, 1968;Flanc, Kakkar, and Clarke, 1968;Negus, Pinto, LeQuesne, Brown, and Chapman, 1968) and radioactive iodine attached to fibrinogen (Hobbs and Davis, 1960;Atkins andHawkins, 1965, 1968;Flanc and others, 1968;Negus and others, 1968) have revealed that, broadly speaking, 35 per cent of all patients over 40 years of age who undergo a surgical operation will develop a deep-vein thrombosis in the lower limbs others, 1968, 1969).…”

mentioning

confidence: 96%